Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer?
Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer?
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DOI：
10.1016/s0959-8049(98)00308-6
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发表时间：
1999-01-01
影响因子：
8.4
通讯作者：
Fallowfield, L
中科院分区：
文献类型：
--
作者：
Hall, A;A'Hern, R;Fallowfield, L
这项前瞻性研究的目的是确定与早期乳腺癌的诊断和治疗相关的精神疾病发病率。在五个时间点的每一个，269名妇女进行了采访，使用缩短版的现状检查（PSE）和266完成自我评估问卷，医院和焦虑抑郁量表（HADS）和鹿特丹症状自评量表（RSCL）。本文比较了能力的问卷调查，以发现精神疾病的PSE。大多数经历过焦虑和/或抑郁的女性在初次手术后3个月内就这样做了。在最初的3个月里，临床访谈确定了266名妇女中的132名（49.6%）患有焦虑症，99名（37.2%）患有抑郁症。使用推荐的阈值大于或等于11的病例，这两个测试的敏感性非常低，在24.2%（HADS焦虑）和14.1%（HADS抑郁）和30.6%（RSCL心理困扰量表）。将HADS的阈值降低到大于或等于7，焦虑子量表的敏感性提高到72%，但抑郁子量表的敏感性仍然较低，为37.4%。RSCL量表的阈值大于或等于7将敏感性提高到66.7%。降低阈值提高了两种仪器的灵敏度，但降低了它们的特异性：阈值越低，被确定为假阳性的妇女人数越多，如果用作筛查工具，这将增加诊所工作人员的工作量。考虑到HADS在区分抑郁症方面的不足，它作为一个单一的量表使用，阈值低至12，导致灵敏度仅为42.7%，这并不奇怪。根据这些发现，我们质疑使用HADS和RSCL作为合适的研究或筛查工具，检测早期乳腺癌的心理发病率。(C)1999爱思唯尔科技有限公司。保留所有权利。
The aim of this prospective study was to identify the psychiatric morbidity associated with the diagnosis and treatment of early breast cancer. At each of five time points, 269 women were interviewed using a shortened version of the Present State Examination (PSE) and 266 completed self-assessment questionnaires, the Hospital and Anxiety Depression Scale (HADS) and the Rotterdam Symptom Checklist (RSCL). This paper compares the ability of the questionnaires to detect psychiatric morbidity with that of the PSE. The majority of women who experienced anxiety and/or depression did so within 3 months of their initial surgery. The clinical interview identified anxiety disorder in 132 of 266 women (49.6%) and depressive illness in 99/266 (37.2%) during the first 3 months. Using the recommended threshold of greater than or equal to 11 for caseness, the sensitivities for both tests were very low at 24.2% (HADS anxiety) and 14.1% (HADS depression) and 30.6% (RSCL psychological distress scale). Lowering the threshold value to greater than or equal to 7 on the HADS improved the sensitivity to 72% for the anxiety subscale, but it remained low at 37.4% for the depression subscale. A threshold of greater than or equal to 7 for the RSCL scale raised sensitivity to 66.7%. Lowering the threshold values raised the sensitivity of both the instruments but decreased their specificity: the lower the threshold, the greater the number of women who were identified as false positives which would increase the work load for clinic staff if used as a screening tool. Given that the HADS was inadequate in discriminating for depressive illness, it was not surprising that its use as a unitary scale with a threshold value as low as 12 resulted in a sensitivity of only 42.7%. In the light of these findings, we question the use of both the HADS and the RSCL as suitable research or screening instruments for detection of psychological morbidity in early breast cancer. (C) 1999 Elsevier Science Ltd. All rights reserved.